Akateh Clifford, Rajab Amer, Henry Mitchell, El-Hinnawi Ashraf
From the Division of Transplant Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Exp Clin Transplant. 2019 Apr;17(2):274-277. doi: 10.6002/ect.2016.0237. Epub 2018 Oct 5.
Since the inception of pancreas transplant as a treatment for type 1 diabetes mellitus, there has been considerable debate about the best way to manage exocrine secretions and monitor patients for graft rejection. For patients who undergo bladder exocrine drainage of a pancreatic allograft, a bladder-to-enteric drainage conversion can serve as a rescue procedure in case of anastomotic leaks or other complications. However, this procedure is associated with its own complications, including a rarely described enterovesical fistula. Here we report on a 45-year-old man who underwent a simultaneous kidney and pancreas transplant with bladder drainage to the latter. He developed a pancreatic allograft duodenal leak (duodenal-vesical anastomosis) requiring a bladder-to-enteric drainage conversion. The patient returned 2 weeks after discharge with an enterovesical fistula. He was treated nonsurgically with intravenous antibiotics, bowel rest, and parenteral nutrition, and the fistula successfully closed in approximately 2 weeks. Overall, enterovesical fistula formation is a rare but treatable complication that can occur after a bladder-to-enteric drainage conversion of a pancreatic transplant allograft. It can be managed nonsurgically, which is preferable in these immunocompromised patients.
自胰腺移植作为1型糖尿病的一种治疗方法开始应用以来，关于处理外分泌以及监测患者移植排斥反应的最佳方式一直存在大量争论。对于接受胰腺同种异体移植膀胱外分泌引流的患者，若发生吻合口漏或其他并发症，膀胱转肠道引流可作为一种补救措施。然而，该手术本身也会引发并发症，包括一种鲜有描述的肠膀胱瘘。在此，我们报告一名45岁男性，他接受了肾胰联合移植，胰腺移植采用膀胱引流。他出现了胰腺同种异体移植十二指肠漏（十二指肠-膀胱吻合口处），需要进行膀胱转肠道引流。患者出院2周后因肠膀胱瘘再次入院。对其采用静脉注射抗生素、肠道休息和肠外营养等非手术治疗，瘘口在约2周内成功闭合。总体而言，肠膀胱瘘形成是胰腺移植同种异体膀胱转肠道引流术后一种罕见但可治疗的并发症。可采用非手术方式处理，这对于这些免疫功能低下的患者更为可取。
